POS1121 HAND OSTEOARTHRITIS IS ASSOCIATED WITH LIMITATIONS IN PAID AN UNPAID WORK PARTICIPATION AND RELATED SOCIETAL COSTS: THE HOSTAS COHORT
Authors: S. Terpstra, L. Van de Stadt, A. Boonen, F. Rosendaal, M. Kloppenburg
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatic musculoskeletal diseases (RMDs) can cause impairment in paid and unpaid work which can contribute to societal burden and costs. However, data on this topic concerning hand osteoarthritis (OA) is scarce, while this is crucial for assessing the societal impact of this disease. Objectives To investigate the association of hand OA with paid and unpaid work limitations, productivity loss and costs of productivity loss. Methods We used data of the Dutch Hand OSTeoArthritis in Secondary care (HOSTAS) cohort, a primary hand OA cohort from a general rheumatology outpatient clinic. The treating rheumatologist defined hand OA presence. We assessed patient and OA characteristics using validated questionnaires and tests. We investigated work impairment due to hand OA with the Health and Labour Questionnaire (HLQ) which assesses the last two weeks on hand-OA related limitations, hours of sick leave and unproductiveness during paid work, and limitations and hours of the necessity of being replaced by others for unpaid work tasks. We estimated societal costs of paid work by multiplying unproductive and sick leave hours due to hand OA by the average Dutch hourly societal costs of paid work for persons of the same age category and sex. We estimated societal costs of unpaid work by multiplying the hours of unpaid work replaced by others by the Dutch gross average hourly salary of a household help (€12.50). Results HLQ data was available for 382 patients (mean age 61 years, 86% women, 26% having a university degree, 41% having any comorbidity). Of these persons, 181 (47%) had paid work, 16 (4%) had full work disability due to hand OA and 117 (30%) were retired. Thirteen employed persons (7%) reported sick leave due to hand OA in the last two weeks, for whom a median of 42 working hours (interquartile range (IQR) 24 to 54) was lost. Unproductive paid work hours were present for 28 (15%) patients, with a median of 4 hours in the last two weeks (IQR 2 to 6). Hinder at work in the last two weeks was reported by 120 out of 181 working patients (66%), for whom median hinder score (score range 6-24) was 7 (IQR 6 to 8). Work production loss in the last two weeks due to hand OA (the sum of sick leave hours and unproductive hours) was present for 36 patients (19%). Patients with paid work productivity loss (n = 35, 19%) did not differ statically significantly in patient and disease characteristics from those without productivity loss (n = 146, 19%). Unpaid work replacement in the last two weeks was reported by 171 patients (45%), with a median of three hours replaced (IQR 2 to 7). Any unpaid work hinder was reported by 297 (78%). Median unpaid work hinder score (score range: 4-16) was 8 (IQR 7 to 10) . Patients with unpaid work replacement by others due to hand OA (n=171, 45%) were statically significantly more often female and had a higher BMI than with those without any replacement (n=210, 55%). We estimated total societal costs of hand OA related to paid work production loss at €61 (95% confidence interval (CI) 27 to 96) per two weeks, and societal costs for unpaid work at €33 (CI 27 to 40). Total estimated work-related societal costs per patient with hand OA were €94 (CI 59 to 130), translating to €2452 (CI 1528 to 3377) per year. Conclusion Hand OA is associated with impairment in paid and unpaid work, which translates into substantial societal costs. This highlights the social and economic importance of adequate hand OA treatment. It also highlights the importance of investigating work impairment experienced by hand OA patients visiting the outpatient clinic, for potentially more tailored treatment. Disclosure of Interests None declared